Agencies fear hidden cholera deaths in Yemen as Covid-19 overwhelms clinics

Thousands of deaths potentially missed as patients avoid health centres, with both diseases set to peak in coming weeks, warn NGOs

Aid agencies are warning that thousands of people in Yemen could be dying undetected from cholera as people are too frightened to seek treatment in health facilities overwhelmed by coronavirus.

Coronavirus cases in the war-torn country are due to peak in the coming weeks, but Oxfam has warned that health centres are seeing an unexpected drop in cholera cases, ahead of August’s rains when cholera will also increase.

Already experiencing what has been described as the world’s worst humanitarian crisis, with approximately 80% of the population requiring urgent assistance, Yemen is also facing a worsening food crisis.

The country also suffered the worst cholera outbreak in modern times, with 110,000 cases between January and April this year.

A 50% drop in people seeking treatment for cholera in the past three months has led to concern that tens of thousands of people are avoiding health centres for fear of contracting Covid-19.

That concern has been compounded by the fact that, according to estimates by the World Health Organization, half of those diagnosed with cholera in the country will die from the disease if it is left untreated.

Already around 20% of the country’s 333 districts have no medical doctors, with numbers continuing to decline as scores of doctors die from the virus.

The first case of coronavirus reported in the country was in April and although officially only 1,644 cases had been recorded by 22 July, the actual figure is likely to be far higher because of underreporting and a lack of testing facilities.

Muhsin Siddiquey, Oxfam’s Yemen country director, said: “Yemen is on course for a truly horrific catastrophe as both cholera and Covid could peak in the coming weeks. Yemenis desperately need an end to the fighting which has destroyed health facilities and left communities more vulnerable to the virus.

“Rather than show that Yemen has cholera and Covid under control, the low official numbers demonstrate the exact opposite. A lack of working health facilities and people too scared to get treatment mean that the numbers suffering from these diseases are being vastly under recorded.”

Yemen has also been hit by the economic fall out from the coronavirus. A slump in remittances and even tighter restrictions on vital food imports mean there have been huge increases in the price of food and millions of Yemenis are being pushed deeper into a hunger crisis.

Funding for Yemen’s humanitarian crisis is on the brink of collapse at a time when the crisis has never been worse, Mark Lowcock, the UN’s humanitarian chief told the UN security council on Tuesday in the grimmest summary of the crisis given by a UN official in the five-year civil war.

“Famine is again on the horizon. Conflict is again escalating. The economy is again in tatters. Humanitarian agencies are again nearly broke,” Lowcock said.

He blamed the collapse in funding on a failure by the Gulf States to provide previous levels of funding and said it meant already 8 million Yemenis have had their rations cut in half. The Gulf states have been hit by the fall in oil prices, but may be using a withholding of cash to the UN as leverage to force the Houthi rebel movement to make concessions in faltering peace talks.

Lowcock warned similar sized cuts are affecting “millions of people who rely on aid for water, healthcare and other needs. Aid organisations have so far received about 18% of what we need for this year’s humanitarian response plan. What had in recent years been one of the better funded humanitarian operations around the world is now one of the most underfunded”.

He predicted: “In August, that will mean a 50% cut to water and sanitation programmes in 15 cities around the country. We will also have to stop hygiene activities for people who recently fled their homes. In September, nearly 400 health facilities – including 189 hospitals – will lose supplies of clean water and essential medicines. That could cut off healthcare for 9 million people. Also in September, we will run out of money to treat more than 250,000 children who are suffering from severe malnutrition. Without treatment, those children will die.”

Lowcock warned 16 districts are now categorised as “phase 4”, which is one step away from famine conditions. At the beginning of the year, just two districts had been rated as phase 4.

He also said fighting had intensified with 43 active frontlines in Yemen – compared to 33 in January.

He said: “In June, only 8,100 metric tons of commercial fuel imports reached the port of Hodeidah – by far the lowest amount ever recorded. As a result, drinking water prices have increased, in some cases more than doubling within a few weeks.” Food prices rose by 10% in June alone.

With famine stalking the land, and the country on what he described as an abyss, Lowcock said aid agencies are increasingly affected, with some reporting they can no longer travel to communities to deliver assistance because there is no fuel.

He pointed out air attacks that must have been mounted by the Saudi coalition led to the deaths of at least 12 civilians in an attack on a vehicle in Sa’ada in June, the death of nine civilians in Hajjah and three days later the death of 11 civilians in al-Jawf.

Blaming all sides, he said “the rhetoric on Yemen is often reassuring, and the actions relentlessly ruinous”.

At the same briefing to the UNSC, the UN special envoy on Yemen, Martin Griffiths, said there was no point sugaring the pill by pretending the talks to end the civil war were making much progress. “There was a real danger that the chance for peace would slip away,” amidst the uncontrolled spread of coronavirus and economic collapse, he said.


Peter Beaumont and Patrick Wintour

The GuardianTramp

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